Primary care of the adult heart transplant recipient

Abstract

Heart transplantation for end-stage heart failure is an option in select patients for progressive cardiac pump failure, uncontrolled angina, or refractory ventricular tachycardia. With evolving surgical techniques and advances in immunosuppression since the first heart transplant in 1967, post-heart transplant survival has improved to approximately 90% at 1 year, with a median survival of greater than 15 years (Lund et al., J Heart Lung Transplant 35(10):1158-1169, 2016; McKellar, N Engl J Med 377(23):2211-2213, 2017; Bengel et al., Circulation 106(7):831-835, 2002). The most common causes of early mortality following heart transplantation are graft failure and infection, whereas long-term morbidity stems from multi-organ failure, malignancy, and cardiac allograft vasculopathy (CAV). Heart transplantation volumes have grown in recent years with over 5000 transplantations performed worldwide in 2016 (Khush et al., J Heart Lung Transplant 37(10):1155-1168, 2018). Mechanical circulatory support (MCS) device systems have been developed as a method of bridging patients to heart transplantation while waiting for a suitable donor. In this chapter, we review the indications, immunosuppression, and both short- and long-term complications of heart transplantation that are important for primary care providers.